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Spine
Diagnosis
Neoplasms, Cysts, and Other Masses
Vascular
Vascular Miscellaneous
Subarachnoid Hemorrhage
Subarachnoid Hemorrhage
Kevin R. Moore, MD; Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Subarachnoid hemorrhage (SAH)

              • Definitions

                • Hemorrhage into spinal subarachnoid space from variety of etiologies
                  • Trauma (> 50%)
                    • Motor vehicle accident, occupational, etc.
                    • Postoperative
                    • Lumbar puncture (LP), epidural or intradural catheter placement
                  • Related to brain pathology
                    • Aneurysmal SAH with spinal extension
                  • Spinal arteriovenous malformations (AVMs) 
                    • Mainly types II, III, IVc, conus malformations
                    • Intradural extramedullary cavernous malformation (very rare)
                  • Tumor
                    • Spinal ependymoma
                    • Spinal schwannoma (rare)
                    • Hemangioblastoma (rare)
                    • Astrocytoma (rare)
                    • Endometriosis (rare)
                  • Bleeding diatheses
                  • Anticoagulant therapy
                  • Infection (pneumococcal meningitis, herpes)
                  • Systemic disease
                    • Lupus erythematosus, polyarteritis nodosa
                  • Spinal artery aneurysm (rare)
                    • High-flow varieties associated with AVM or coarctation of aorta
                    • Congenital type seen with collagen gene mutations; connective tissue disorders
                  • Spontaneous idiopathic (rare)

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Angiographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    Selected References

                                    1. Blackburn SL et al: Prospective trial of cerebrospinal fluid filtration after aneurysmal subarachnoid hemorrhage via lumbar catheter (PILLAR). Stroke. 50(9):2558-61, 2019
                                    2. Yost MD et al: Spontaneous spinal subarachnoid hemorrhage: presentation and outcome. J Stroke Cerebrovasc Dis. 27(10):2792-6, 2018
                                    3. Ichiba T et al: Comprehensive evaluation of diagnostic and treatment strategies for idiopathic spinal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 26(12):2840-8, 2017
                                    4. Pahl FH et al: Spontaneous resolution of an isolated cervical anterior spinal artery aneurysm after subarachnoid hemorrhage. Surg Neurol Int. 5:139, 2014
                                    5. Boström A et al: Spinal glomus-type arteriovenous malformations: microsurgical treatment in 20 cases. J Neurosurg Spine. 10(5):423-9, 2009
                                    6. Ros de San Pedro J et al: Massive hemorrhage in hemangioblastomas : Literature review. Neurosurg Rev. 33(1):11-26, 2009
                                    7. Sharma GK et al: Spontaneous intramedullary hemorrhage of spinal hemangioblastoma: case report. Neurosurgery. 65(3):E627-8; discussion E628, 2009
                                    8. Yu SD et al: Factors associated with traumatic fluoroscopy-guided lumbar punctures: a retrospective review. AJNR Am J Neuroradiol. 30(3):512-5, 2009
                                    9. Germans MR et al: Spinal vascular malformations in non-perimesencephalic subarachnoid hemorrhage. J Neurol. 255(12):1910-5, 2008
                                    10. Ginanneschi F et al: Arachnoid cyst and arachnoiditis following idiopathic spinal subarachnoid haemorrhage. Br J Neurosurg. 22(4):578-9, 2008
                                    11. Longatti P et al: Bleeding spinal artery aneurysms. J Neurosurg Spine. 8(6):574-8, 2008
                                    12. Koch C et al: Dural arteriovenous fistula of the lumbar spine presenting with subarachnoid hemorrhage. Case report and review of the literature. J Neurosurg. 100(4 Suppl):385-91, 2004
                                    13. Pancu D et al: EPs do not accept the strategy of "lumbar puncture first" in subarachnoid hemorrhage. Am J Emerg Med. 22(2):115-7, 2004
                                    14. Yahiro T et al: Pseudoaneurysm of the thoracic radiculomedullary artery with subarachnoid hemorrhage. Case report. J Neurosurg. 100(3 Suppl):312-5, 2004
                                    15. Berlis A et al: Subarachnoid haemorrhage due to cervical spinal cord haemangioblastomas in a patient with von Hippel-Lindau disease. Acta Neurochir (Wien). 145(11):1009-13; discussion 1013, 2003
                                    16. Bertalanffy H et al: Isolated paramedullary hemangioblastoma originating from the first cervical nerve root: case report. Spine. 28(10):E191-3, 2003
                                    17. Chatterjee T et al: Pneumococcal meningitis masquerading as subarachnoid haemorrhage. Med J Aust. 178(10):505-7, 2003
                                    18. Kastenbauer S et al: Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases. Brain. 126(Pt 5):1015-25, 2003
                                    19. Nozaki K et al: Spinal intradural extramedullary cavernous angioma. Case report. J Neurosurg. 99(3 Suppl):316-9, 2003
                                    20. Rabinov JD et al: Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol. 24(7):1421-8, 2003
                                    21. Shah KH et al: Incidence of traumatic lumbar puncture. Acad Emerg Med. 10(2):151-4, 2003
                                    22. Yamaguchi S et al: Spinal subdural hematoma: a sequela of a ruptured intracranial aneurysm? Surg Neurol. 59(5):408-12; discussion 412, 2003
                                    23. Fahy BG et al: Current concepts in neurocritical care. Anesthesiol Clin North America. 20(2):441-62, viii, 2002
                                    24. Pai SB et al: Post lumbar puncture spinal subarachnoid hematoma causing paraplegia: a short report. Neurol India. 50(3):367-9, 2002
                                    25. Wells JB et al: Subarachnoid hemorrhage presenting as post-dural puncture headache: a case report. Mt Sinai J Med. 69(1-2):109-10, 2002
                                    26. Wityk RJ et al: Neurovascular complications of marfan syndrome: a retrospective, hospital-based study. Stroke. 33(3):680-4, 2002
                                    27. Cihangiroglu M et al: Spinal subarachnoid hemorrhage complicating oral anticoagulant therapy. Eur J Radiol. 39(3):176-9, 2001
                                    28. Cruickshank AM: ACP Best Practice No 166: CSF spectrophotometry in the diagnosis of subarachnoid haemorrhage. J Clin Pathol. 54(11):827-30, 2001
                                    29. Hausmann et al: Coagulopathy induced spinal intradural extramedullary hematoma: report of three cases and review of the literature. Acta Neurochir (Wien). 143(2):135-40, 2001
                                    30. Hosoda H et al: Mediastinal neurilemmoma complicated with spinal subarachnoid hemorrhage. Jpn J Thorac Cardiovasc Surg. 49(6):384-7, 2001
                                    31. Ruelle A et al: Spinal subarachnoid bleeding of unknown etiology. Case reports. J Neurosurg Sci. 45(1):53-7, 2001
                                    32. Bhangoo RS et al: Cavernous angiomas of the brain stem and spinal cord. J Clin Neurosci. 5 Suppl:20-5, 1998
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Pathology

                                            • Clinical Issues

                                              • Diagnostic Checklist

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Subarachnoid hemorrhage (SAH)

                                                • Definitions

                                                  • Hemorrhage into spinal subarachnoid space from variety of etiologies
                                                    • Trauma (> 50%)
                                                      • Motor vehicle accident, occupational, etc.
                                                      • Postoperative
                                                      • Lumbar puncture (LP), epidural or intradural catheter placement
                                                    • Related to brain pathology
                                                      • Aneurysmal SAH with spinal extension
                                                    • Spinal arteriovenous malformations (AVMs) 
                                                      • Mainly types II, III, IVc, conus malformations
                                                      • Intradural extramedullary cavernous malformation (very rare)
                                                    • Tumor
                                                      • Spinal ependymoma
                                                      • Spinal schwannoma (rare)
                                                      • Hemangioblastoma (rare)
                                                      • Astrocytoma (rare)
                                                      • Endometriosis (rare)
                                                    • Bleeding diatheses
                                                    • Anticoagulant therapy
                                                    • Infection (pneumococcal meningitis, herpes)
                                                    • Systemic disease
                                                      • Lupus erythematosus, polyarteritis nodosa
                                                    • Spinal artery aneurysm (rare)
                                                      • High-flow varieties associated with AVM or coarctation of aorta
                                                      • Congenital type seen with collagen gene mutations; connective tissue disorders
                                                    • Spontaneous idiopathic (rare)

                                                IMAGING

                                                • General Features

                                                  • CT Findings

                                                    • MR Findings

                                                      • Angiographic Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Staging, Grading, & Classification

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Consider

                                                                      Selected References

                                                                      1. Blackburn SL et al: Prospective trial of cerebrospinal fluid filtration after aneurysmal subarachnoid hemorrhage via lumbar catheter (PILLAR). Stroke. 50(9):2558-61, 2019
                                                                      2. Yost MD et al: Spontaneous spinal subarachnoid hemorrhage: presentation and outcome. J Stroke Cerebrovasc Dis. 27(10):2792-6, 2018
                                                                      3. Ichiba T et al: Comprehensive evaluation of diagnostic and treatment strategies for idiopathic spinal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 26(12):2840-8, 2017
                                                                      4. Pahl FH et al: Spontaneous resolution of an isolated cervical anterior spinal artery aneurysm after subarachnoid hemorrhage. Surg Neurol Int. 5:139, 2014
                                                                      5. Boström A et al: Spinal glomus-type arteriovenous malformations: microsurgical treatment in 20 cases. J Neurosurg Spine. 10(5):423-9, 2009
                                                                      6. Ros de San Pedro J et al: Massive hemorrhage in hemangioblastomas : Literature review. Neurosurg Rev. 33(1):11-26, 2009
                                                                      7. Sharma GK et al: Spontaneous intramedullary hemorrhage of spinal hemangioblastoma: case report. Neurosurgery. 65(3):E627-8; discussion E628, 2009
                                                                      8. Yu SD et al: Factors associated with traumatic fluoroscopy-guided lumbar punctures: a retrospective review. AJNR Am J Neuroradiol. 30(3):512-5, 2009
                                                                      9. Germans MR et al: Spinal vascular malformations in non-perimesencephalic subarachnoid hemorrhage. J Neurol. 255(12):1910-5, 2008
                                                                      10. Ginanneschi F et al: Arachnoid cyst and arachnoiditis following idiopathic spinal subarachnoid haemorrhage. Br J Neurosurg. 22(4):578-9, 2008
                                                                      11. Longatti P et al: Bleeding spinal artery aneurysms. J Neurosurg Spine. 8(6):574-8, 2008
                                                                      12. Koch C et al: Dural arteriovenous fistula of the lumbar spine presenting with subarachnoid hemorrhage. Case report and review of the literature. J Neurosurg. 100(4 Suppl):385-91, 2004
                                                                      13. Pancu D et al: EPs do not accept the strategy of "lumbar puncture first" in subarachnoid hemorrhage. Am J Emerg Med. 22(2):115-7, 2004
                                                                      14. Yahiro T et al: Pseudoaneurysm of the thoracic radiculomedullary artery with subarachnoid hemorrhage. Case report. J Neurosurg. 100(3 Suppl):312-5, 2004
                                                                      15. Berlis A et al: Subarachnoid haemorrhage due to cervical spinal cord haemangioblastomas in a patient with von Hippel-Lindau disease. Acta Neurochir (Wien). 145(11):1009-13; discussion 1013, 2003
                                                                      16. Bertalanffy H et al: Isolated paramedullary hemangioblastoma originating from the first cervical nerve root: case report. Spine. 28(10):E191-3, 2003
                                                                      17. Chatterjee T et al: Pneumococcal meningitis masquerading as subarachnoid haemorrhage. Med J Aust. 178(10):505-7, 2003
                                                                      18. Kastenbauer S et al: Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases. Brain. 126(Pt 5):1015-25, 2003
                                                                      19. Nozaki K et al: Spinal intradural extramedullary cavernous angioma. Case report. J Neurosurg. 99(3 Suppl):316-9, 2003
                                                                      20. Rabinov JD et al: Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol. 24(7):1421-8, 2003
                                                                      21. Shah KH et al: Incidence of traumatic lumbar puncture. Acad Emerg Med. 10(2):151-4, 2003
                                                                      22. Yamaguchi S et al: Spinal subdural hematoma: a sequela of a ruptured intracranial aneurysm? Surg Neurol. 59(5):408-12; discussion 412, 2003
                                                                      23. Fahy BG et al: Current concepts in neurocritical care. Anesthesiol Clin North America. 20(2):441-62, viii, 2002
                                                                      24. Pai SB et al: Post lumbar puncture spinal subarachnoid hematoma causing paraplegia: a short report. Neurol India. 50(3):367-9, 2002
                                                                      25. Wells JB et al: Subarachnoid hemorrhage presenting as post-dural puncture headache: a case report. Mt Sinai J Med. 69(1-2):109-10, 2002
                                                                      26. Wityk RJ et al: Neurovascular complications of marfan syndrome: a retrospective, hospital-based study. Stroke. 33(3):680-4, 2002
                                                                      27. Cihangiroglu M et al: Spinal subarachnoid hemorrhage complicating oral anticoagulant therapy. Eur J Radiol. 39(3):176-9, 2001
                                                                      28. Cruickshank AM: ACP Best Practice No 166: CSF spectrophotometry in the diagnosis of subarachnoid haemorrhage. J Clin Pathol. 54(11):827-30, 2001
                                                                      29. Hausmann et al: Coagulopathy induced spinal intradural extramedullary hematoma: report of three cases and review of the literature. Acta Neurochir (Wien). 143(2):135-40, 2001
                                                                      30. Hosoda H et al: Mediastinal neurilemmoma complicated with spinal subarachnoid hemorrhage. Jpn J Thorac Cardiovasc Surg. 49(6):384-7, 2001
                                                                      31. Ruelle A et al: Spinal subarachnoid bleeding of unknown etiology. Case reports. J Neurosurg Sci. 45(1):53-7, 2001
                                                                      32. Bhangoo RS et al: Cavernous angiomas of the brain stem and spinal cord. J Clin Neurosci. 5 Suppl:20-5, 1998